Public Health England (PHE) is warning parents to be vigilant in light of “steep increases” in cases of Scarlet Fever - a relatively common but potentially serious childhood illness characterised by a bright pink or red rash across the cheeks and body and swollen tongue accompanied by a high fever.

Cases of Scarlet fever have been steadily increasing over the past few years and have now reportedly reached levels not seen in almost half a century, with 600 new cases currently being diagnosed each week throughout England. Caused by the bacterium streptococcus A, Scarlatina was a leading cause of death among children in the early 20th century, but the disease is now curable with prompt and appropriate antibiotic treatment in order to avoid complications. There is currently no vaccine.

Dr Theresa Lamagni, PHE’s head of streptococcal infection surveillance, is reminding parents that they “can play a key role in recognising when their child needs to be seen by their GP”.

Dr Lamagni says: “Early signs to look out for are sore throat, headache and fever with the characteristic pinkish/red sandpapery rash appearing within a day or two, typically on the chest and stomach but then spreading to other parts of the body. Individuals who think they or their child may have scarlet fever should seek advice from their GP without delay as prompt antibiotic treatment is needed.

“Symptoms usually clear up after a week and the majority of cases will resolve without complication as long as the recommended course of antibiotics is completed. Potential complications include ear infection, throat abscess and pneumonia. Patients who do not show signs of improvement within a few days of starting treatment should seek urgent medical advice.

“As scarlet fever is highly contagious, children or adults diagnosed with scarlet fever are advised to stay off school or work until at least 24 hours after the start of antibiotic treatment to avoid passing on the infection.

“Where outbreaks occur, PHE local Health Protection Teams (HPTs) are on hand to provide a rapid response, effective outbreak management and authoritative advice. Schools, nurseries and childcare settings should embed good hand hygiene practice within daily routines for pupils and staff and alert their local PHE HPT if an outbreak of scarlet fever is suspected. Children and adults should be encouraged to cover their mouth and nose with a tissue when they cough and sneeze and to wash their hands after using or disposing of tissues.”

Scarlet fever season usually begins in December, peaking in March and April, however the 2014 season saw cases reach levels not seen since 1969, a trend which is said to have continued into the current season. PHE says the reasons for this remain unclear, and may simply reflect a long-term natural cycle of disease since bacteria samples from patients exclude the possibility of a newly emerging strain.

How is Scarlet fever contracted?

Scarlet fever is caused by exposure to streptococcus A bacteria, spread through the coughs and sneezes of an infected person. Outbreaks commonly occur in nurseries and primary schools, where groups of children are in close contact with one another.

Scarlet fever usually appears after exposure to bacterium, for example following a throat infection or the skin infection impetigo. But you may not even be aware of the source of infection, as the bacteria can survive on surfaces or be picked up through close contact with a bacteria carrier – who may not have any symptoms.

Scarlet fever can also be spread through sharing contaminated bedding and towels. Some people carry the bacteria on their skin or in the back of the throat but do not develop any symptoms, as most people will have developed immunity by the time they reach 10 years of age. Any carriers can, however, still spread the bacteria to others which reinforces the need for good hygiene practice among all age groups.

Scarlet fever primarily affects children between the ages of two and eight, but can occur at any age.

What are the symptoms?

Early symptoms include:

Sore throat

Headache

Fever or temperature above 38.3C/101F

Followed after 1 – 2 days by:

‘Strawberry tongue’, where the tongue has a bright red appearance with visible dots and may feel swollen

Fine, raised pink or red ‘sandpaper’ rash on the cheeks and neck, chest, back and limbs

With the correct treatment, Scarlet fever usually improves in around a week.